Focus on Command Term - Examine

﻿Consider an argument or concept in a way that uncovers the assumptions and interrelationships of the issue. ﻿

﻿Level 3﻿

﻿You therefore need to make sure that you have identified some assumptions and interrelationships which you can comment on in your essay.﻿

﻿Assignment 1 - what is 'abnormal'?﻿

﻿Look at the picture of One Direction on the right. All of them are admitting to some unusual behaviour... but which would you diagnose as 'abnormal'?

For each band member, decide if the behaviour is abnormal or not. Write a brief justification (3-4 lines for each person) of your views.﻿

Remember... the command term asks you to 'examine' so you need to be aware of the assumptions and interrelationships of abnormality. What are the assumptions of our everyday ideas about normality and abnormality?

Definitions of abnormality

There are 4 different methods of defining abnormality which you need to know. Different definitions may be more effective for different situations. Listen to this podcast, then read the descriptions below...

Deviation from statistical norms

This definition asks one simple question:

How unusual is the behaviour being displayed?

If it is statistically unusual, then it is classed as abnormal. For this reason, the explanation is sometimes known as 'statistical infrequency'.

Using a normal distribution (see above), we can identify people who are a long way from the mean.

However, an obvious problem here is that this doesn't take into account whether the behaviour is desirable or not (e.g. is a high IQ 'abnormal'?)

﻿Violating social norms﻿

Societies and cultures all have a number of unwritten rules of behaviour which most people follow. These are called social norms.

For example:If someone does not say thank you if you do them a favour, you might feel that this violates a social norm of being polite.

In extreme cases, violating social norms could allow a diagnosis of abnormality.

However, social norms may change over time and between cultures and areas (or even families). Who is to say which set of norms we use as our baseline?

You could perhaps argue that the case of Genie illustrates this, as through extreme deprivation she never learned the appropriate social norms. (Though of course, given the severity of her condition, she undoubtedly fulfils the other definitions as well).

﻿Deviation from ideal mental health﻿

Are 'normal' people always this happy?

﻿Rather than look at what is 'abnormal', we could start by deciding what is 'normal' and then find people who do not display 'normal' characteristics. Defining normality is, of course, just as hard as defining abnormality, but psychologists will often include:

Positive view of the self

Capability for growth and development

Autonomy and independence

Accurate perception of reality

Positive friendships and relationships

However, do normal people exhibit all of these all the time? I certainly don't! Also, these definitions of normality﻿﻿are very ethnocentric.﻿

Caspi et al (2003) could be used as an example of where a genetic marker was found which illustrated a tendency to deviate from ideal mental health more easily than some other people.

﻿Failure to function adequately﻿

Most people who ask for psychological help are suffering from distress. Rosenhan and Seligman (1989) suggested that this could be used to help define abnormality. People failing to function may display:

Suffering

Maladaptiveness (danger to self)

Vividness & unconventionality (stands out)

Unpredictably & loss of control

Irrationality/ incomprehensibility

Causes observer discomfort

Violates moral/social standards

One problem here is that sometimes these behaviours could be helpful or even enjoyable! Extreme sports could be maladaptive. Vividness can help to make people successful etc.

Bremner et al's (2003) study into PTSD clearly illustrates these failure to function characteristics in the symptoms displayed by the victims of abuse studied.

Linking these different definitions of abnormality to what we've studied in Paper 1...

In the descriptions above are links to some studies which we've already covered, which help to illustrate either advantages or disadvantages with the different definitions of abnormality. Can you think of any more?

﻿Assignment 2 - applying definitions to the real world﻿

﻿﻿﻿Look back at the picture of One Direction. Which definition of abnormality would be most appropriate for each of their behaviours? Now fill in this document with a detailed argument for the three cases given.﻿﻿﻿

Hopi Indians have no word for ‘depression.’ Does this mean it doesn't exist in their culture?

Assignment 3 - Definitions factsheet

Further evidence on 'normality' and 'abnormality'

The three essays here all overlap hugely (see right). It is not something that can be learned in separate boxes.

For example:

One reason it is hard to define abnormality accurately is because it varies so much across different cultures.

This variation in definition and diagnosis clearly makes it extremely difficult to diagnose with any reliability or validity!

This means that you should not attempt to practise any of the essays covered on this page until you have read and understood ALL of it,in detail. Evidence from all of the sections can be used for each question, providing you shape what you're writing to the specific question being asked.

You may disagree that this is the correct shaped Venn diagram for the relationships shown. How would you depict it?

Assignment 4 - 22 mark question

Examine concepts of normality and abnormality (22)

Remember that the sections should overlap, so you should only write this essay after having read all of the page. You can use information from the whole page to help you explore your answer. See to the right for help in addressing the 'examine' command term.

What ARE the 'assumptions' of ideas of normality and abnormality?

It is not immediately obvious what the 'assumptions' here might be. However, I think that the idea that 'there are clear differences between the normal and the abnormal... and these differences can be reliably identified' might be a commonly held assumption. 'Abnormal psychology conditions are universal' might perhaps be another. The interrelationships analysed can be the relationship of the three factors above.

Discuss the validity and reliability of diagnosis

General introduction to problems with defining abnormality

﻿One major problem with defining what is abnormal is that the definition will vary between different cultures. Some disorders are culture-bound (they only occur in certain﻿ cultures and are unheard of in others). For example, anorexia may only occur in Western countries, so may be a culture-bound disorder. Some of these are fascinating - see this list for the top ten weirdest! The section below covers this in more detail.

There are no universal indicators of mental illness! In other words, everyone is different and each sufferer will have their own unique combination of symptoms. It is therefore impossible to find one shared characteristic which can be defined as 'abnormal'. The DSM uses checklists of behaviours, which patients are expected to show some of but not all.

Both of these points question the validity of any definition of abnormality.﻿

General introduction to problems with diagnosing mental illness

Would this label be helpful to a sufferer?

﻿Reliability of diagnosis? Would different clinicians using the same diagnostic systems agree on the ﻿diagnosis
﻿given to an individual? Given that diagnosis relies on the subjective interpretation of the therapist, their opinions may vary. Beck et al (1962) found that agreement on diagnosis for 153 patients between two psychiatrists was only
54% - there was very low reliability.

﻿Validity of diagnosis? As well as the point about validity of definitions (above), we can also question the validity, or accuracy, of the diagnosis. If psychiatrists' diagnoses have low reliability (e.g. the Beck et al evidence above), then presumably they can't be very valid either! They can't be diagnosing the thing accurately if they disagree about what it is!

Also, we can question the usefulness of a diagnosis of abnormality.Whilst a diagnosis may be useful is allowing someone access to specialist help which they would not otherwise have had,﻿it can also be very harmful. There is a social stigma around mental illnesses, which can lead to ethical (protection from harm) problems such as labelling. ﻿

﻿How do we diagnose mental illness? Introducing the DSM﻿

the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It provides a common language for clinicians to communicate about ﻿t﻿heir patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders. It also provides a common language for researchers to study the criteria for potential future revisions and to aid in the development of medications and other interventions.

This Education Portal video also gives you a good introduction to the DSM. As you learn about it, try to relate this to ideas of reliability and validity. Why would it be a good idea to have a "common language" for people to use when diagnosing mental illness? What benefits should this bring? Can you foresee any drawbacks?

Evaluating the DSM

The strength of the DSM has usually been “reliability” – each edition has ensured that clinicians use the same terms in the same ways.

The weakness is its lack of validity. Diagnoses are still based on mainly subjective interpretations of symptoms by a clinician. This is not a process which has happened in other parts of medicine for more than 50 years, but for mental health conditions we seem to be stuck without any clear biological markers on which to base a diagnosis.

DSM-V - Volume number 5

Since it was first released in 1952, the DSM have been periodically updated to reflect changing scientific and social understanding of mental illness. Sometimes these changes can seem shocking in hindsight (homosexuality was included as a mental illness of 'sexual deviance' in the first two volumes, before being removed in the 1970s)

There are numerous small updates to each edition, but there have been 5 major reorganisations of the manual, the most recent of which came out in 2013.

The DSM is a controversial document, however. Its categorisation of mental illness is often seen as being more reflective of political or social prejudices than of any true biological categories of illness. There have also been accusations of DSM members being influenced by drug companies (in whose interest it is to have as many conditions as possible listed, so that they can see more drugs for the all! 'Binge eating' and 'hoarding disorder' are two new diagnoses, for example).

On being sane in insane places - Rosenhan, D.L. (1973)

Rosenhan's famous study is the classic demonstration of how psychiatric diagnoses can be biased and unreliable (though precisely how successfully Rosenhan demonstrated this is still up for debate, as we shall see).

There is a full page on the Rosenhan study on the AS Level section of the site, with a large amount of relevant information on there. The key info, however, is below:

Assignment 5 - reviewing evidence and theories on the reliability and validity of diagnosis

Read the above document which contains more information about the problems introduced above. THIS IS GREAT EVIDENCE AND ANALYSIS FOR USE IN AN ESSAY.

Assignment 6 - 22 mark essay question

Discuss validity and reliability of diagnosis (22)Use the information above, and in the document to the left, to help you. Remember that the sections should overlap, so you can use issues with the definition of abnormality here too. For example, the fact that we have no clear definition of normality and abnormality makes it very hard to decide what is a valid diagnosis!

Discuss cultural and ethical considerations in diagnosis

Again, there is huge overlap here with what we have look at already, and we have already looked at some evidence which could be used in an essay on this topic.

What does the question want?

The use of the word 'and' in the title is important here. It suggests that, as well as a 22 mark question, you could also be asked about just one of either cultural OR ethical considerations, for example in an 8 mark SAQ.

E.g. Explain factors related to ethical considerations in the diagnosis of abnormality (8)

Cultural relativism and mental illness

We've already seen the idea of labelling above, but this can be analysed in some more detail here.

At it's heart, Labelling Theory suggests that all mental illnesses are culturally realtive, in other words they are specific to the culture that they occur in and merely reflect the characterisitcs of that culture, rather than reflecting any 'truth' about the condition of the sufferer. Key points below:

Scheff's (1966) labelling theory argues that once assigned by a diagnosis, individuals who have been labelled as schizophrenic may be rewarded with attention and sympathy (reinforced) for behaving bizarrely

This is known as secondary gain.

This bizarre behaviour becomes more and more exaggerated as the role is conformed to and the label becomes a self-fulfilling prophecy.

Szasz (1974) has taken this idea a step further by arguing that schizophrenia is a myth created by society to control those who are different.

Diagrammatic representation of Scheff's (1966) Labelling Theory.

RD Laing, a humanistic psychiatrist, developed Szasz’s idea still further by arguing that schizophrenia could be reinterpreted as a rational response to the patient’s surroundings and circumstances! In other words it is society that is mad, not the patient. 'Schizophrenic behaviour' is as rational response as any to a society that it itself insane.

Culture-bound mental illnesses

There are many instances where mental illnesses seem to appear only in certain cultures. These are termed 'culture-bound' illnesses. They may have characteristics which are similar to some more commonly diagnosed conditions, but they also have unique features which are specific to their cultural context. In order to link usefully to the upcoming sections on anxiety and depression, one culture-bound anxiety disorder and one depressive disorder are described below.

Koro

Koro is a disorder mainly associated with Chinese and South-East Asian regions, involving the intense fear that one's genitals will retract inside the body causing death!

The DSM-V lists Koro in its'Glossary of Culture-Bound Syndromes of Appendix I', and it has been suggested that the disorder can be categorised as a "specific, culture-imposed nosophobia" (nosophobia is the fear of contracting a disease).

Ng (1969) reported on an outbreak of Koro in Singapore in 1967, and numerous other 'outbreaks' have also been reported. Similar symptoms have been reported for individuals in other countries (e.g. UK and US, Berrios et al, 1984), but these are almost always individuals with unusual sexual histories, not the mass hysteria outbreaks seen in SE Asia.

Assignment 7 - Analysing culture-bound syndromes

What does the existence of culture-bound syndromes tell us about abnormality, and our explanations and diagnosis of it?

Brain Fag

Brain fag was first reported from Nigeria, specifically in school and university students.

There are a number of symptoms, which cover areas similar to other affective disorders such as major depression...

Ola et al (2009) found that reported symptoms of brain fag could be linked to classical diagnoses of either anxiety or depression

Brain fag may therefore be comparable to the diagnosis of 'neurasthenia' (weak nerves) in China, rather than depression.

Triangulation and making links... emic and etic approach

You've got lots of useful research to illustrate the emic and etic approaches to psychological research, and to be able to discuss the strengths and weaknesses of these... WHY NOT USE THEM HERE?

E.g. The DSM takes an etic approach to diagnosis of mental illness. This is perhaps a necessary step as it allows us to make comparisons between different cultures and ensures a reliability in the criteria being used for diagnosis... HOWEVER this of course brings with it accusations of ethnocentric bias and validity issues due to the inconsistent application of the diagnostic criteria.

You could expand discussions like this in more detail, using what you have studied on emic and etic approaches.